This revised Mentored Patient-Oriented Research Career Development Award ,(K23) application is a request to support the training and research activities necessary for Kevin Duff, Ph.D. to further develop a novel cognitive index (i.e., practice effects), which could assist in the prediction of outcomes in Mild Cognitive Impairment (MCI). Although the concept of MCI has'advanced our understanding of the transition between normal aging and dementia, it remains an imperfect heuristic for identifying which patients will progress to dementia, and which will not.The current research proposal will examine if there is an inverse relationship between practice effects and cognitive outcome, so that an absence of practice effects increases the risk for conversion to dementia in amnestic MCI across 2 years;and, conversely, robust practice effects are associated with a decreased risk for dementia. Specifically, this research plan will address the following research aims: 1) determine if practice effects predict conversion to dementia in MCI, and 2) examine a variety of moderators of practice effects, and see how they affect conversion rates. The training plan detailed in this application offers a multidisciplinary program capitalizing on the diverse resources available at the University of Iowa and on the expertise of national researchers in memory disorders. As a neuropsychologist, Dr. Duff has set the following training goals: 1) develop skills necessary to further develop practice effects as a predictor of cognitive decline, 2) gain additional expertise in tracking cognitive decline in MCI and diagnosing dementia, 3) gain knowledge in identifying moderators of MCI to dementia conversion, and 4) expand knowledge of statistical techniques necessary for answering these questions. Additionally, training will be provided in conducting ethical research and grant writing. The training and proposed project will lay the foundation for Dr. Duffs long-term scientific goal of creating an independent and externally-funded program of research on examining markers of disease progression in normal aging, MCI, and dementia. Identifying early markers of progression from normal aging to MCI to dementia clearly fits with the mission of the National Institute on Aging, in that, it provides greater knowledge about aging and aging- related diseases. Additionally, identification of early cognitive disorders can have profound public health significance with inaccurate or delayed identification of these disorders leading to missed opportunities for treatment and medical, legal, and family planning. Finally, the availability of a brief, non-invasive, and cost effective marker of disease progression would allow for more efficient and better powered clinical trials.